1. Dear Editor

Given the increasing concerns about mental health problems among adolescents and young people, especially in Iran, it is imperative that national education and health systems seriously consider strengthening and developing school-based mental health (SBMH) services. School-based health centers (SBHCs) offer a range of mental health services including crisis response, thorough individual assessment and treatment, case coordination, support for classroom behavior and academic performance, counseling for substance use, evaluation and management of learning difficulties, peer conflict resolution, and the prescription and oversight of behavioral health medications ( 1 ). According to a multi-provincial epidemiological study in Iran, mental health problems among adolescents are on the rise ( 2 ) and demonstrates the need for urgent and effective action to promote students’ mental health. In particular, given the prevalence of suicidal behaviors and anxiety among Iranian students, establishing SBMH systems that include multidisciplinary teams with the presence of school nurses is of particular importance.

2. Mental Health Situation in Iran

The prevalence of mental health problems among Iranian adolescents has increased in recent years. According to a recent meta-analysis study, cognitive issues such as depression, anxiety, and suicide among students are significantly increasing ( 3 ). In recent years, suicide among Iranian adolescents has become a critical public health issue ( 4 ). A study by Jalali and colleagues indicated that being a male is a significant risk factor associated with substance use, including alcohol and smoking, as well as engagement in risky sexual behaviors, depression, and suicidal tendencies among adolescents. Furthermore, both age and educational attainment were found to have a positive and significant correlation with mental health status ( 5 ). These alarming statistics make it necessary to develop comprehensive and integrated measures to address the mental health crisis in schools.

3. The Role of School Nurses in SBMH (School-Based Mental Health) Teams

Adolescents who struggle with mental health problems are often at greater risk of serious health problems, such as violence, risky behaviors, and academic failure ( 6 ). Research showed that building strong relationships between students and schools can significantly support their mental health ( 7 ). In this regard, as key members of SBMH teams, school nurses play an essential role in identifying and assessing mental health problems. These nurses are wildly successful in identifying students who do not directly express their mental health problems. These students often visit the school health room frequently and report physical symptoms such as stomachache, nausea, or headache, which are usually caused by stress and psychological distress ( 8 ).

In many developed countries, school nurses play a key role in multidisciplinary teams to promote student mental health. In collaboration with psychologists, counselors, and school administrators, these teams can identify and manage students’ psychological needs ( 9 , 10 ). Research indicated that students prefer to visit the school health room to receive mental health services, as this location provides a familiar and safe space for them ( 8 ).

4. Challenges and Opportunities

4.1. Challenges: Integrating school nurses into Iran’s school-based mental health service system faces obstacles and challenges. The most critical challenges are financial, educational, and organizational resource constraints. One of the significant challenges is the lack of financial resources and adequate budget allocation for specialized training of school nurses in the mental health field. This leaves nurses without the skills needed to identify and manage students’ mental health problems. In addition, the lack of effective coordination between educational, health, and government institutions can hinder the effective implementation of school-based mental health service systems. Cultural and social challenges, including stigma and lack of awareness in the community about the importance of mental health issues, can also lead to non-acceptance of mental health services. In some areas, these attitudes cause students and families to refrain from seeking mental health services.

4.2. Opportunities: Despite the challenges mentioned above, there are also certain opportunities to strengthen school-based mental health services in Iran. One of the most important opportunities is the increased awareness and specialized training of school nurses in mental health. Specialized training can enable nurses to participate more effectively in identifying and managing students’ mental health problems. Closer collaboration between school nurses and other members of multidisciplinary teams, including psychologists, counselors, and social workers, can lead to faster identification and timely interventions for students’ mental health issues. Also, developing supportive policies by the government and educational institutions regarding the allocation of financial resources, improving educational infrastructure, and providing appropriate conditions for the implementation of SBMH programs can help improve the effectiveness of these services. Also, public acceptance and promotion of a mental health culture in schools can significantly contribute to reducing stigma and facilitating students’ access to mental health services.

5. Conclusions

Given the growing crisis of mental health problems among Iranian adolescents, it is essential to pay more attention to the integration of school nurses into SBMH teams. This measure can not only help improve students’ quality of life but will also be effective in preventing mental health problems in the future. To achieve this goal, it is necessary to develop more coordinated educational and health policies at the national level so that school nurses can effectively participate in multidisciplinary teams and student mental health services.

Authors’ Contribution

Zahra Saboohi: Contributed to the conception of the work; drafted the work. Mahsa Nazarnia: Contributed to the design of the work; reviewed the work critically for important intellectual content. All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work, such as the questions related to the accuracy or integrity of any part of the work.

Conflict of Interest

None declared.

Funding

None.

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